Delayed Posttraumatic Spinal Epidural Hematoma: Importance of Early Surgical Treatment for Neurologic Deficits

─ 176 ─ eISSN 2287-1683 pISSN 1738-8767

Journal of Trauma and Injury Vol. 29, No. 4, December, 2016 http://dx.doi.org/10.20408/jti.2016.29.4.176

� Case Report �

� Address for Correspondence : Deok Heon Lee, M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea

Tel : 82-53-200-5665, Fax : 82-53-421-0510, E-mail : [email protected]

Submitted : November 14, 2016 Revised : November 14, 2016 Accepted : December 30, 2016

Delayed Posttraumatic Spinal Epidural Hematoma: Importance of Early Surgical Treatment for Neurologic Deficits

Deok Heon Lee, M.D., Tak-Hyuk Oh, M.D., Jong-Chul Lee, M.D.

, Kyoung Hoon Lim, M.D.

Department of Thoracic and Cardiovascular Surgery,

Department of Orthopedic Surgery,

2

Department of Surgery, Kyungpook National University Hospital, Daegu, Korea

Delayed posttraumatic spinal epidural hematoma is an extremely rare disease, and it remains a challenge for surgical teams of trauma centers. Magnetic resonance imaging is an essential tool for early diagnosis, and emergent evacuation of the hematoma is the best choice of treatment. We report the case of a 33-year old man with posttraumatic epidural hematoma in the thoracic spine (T10 and T11 levels), who developed an abrupt-onset paraplegia 5 days after the trau- ma. [ J Trauma Inj 2016; 29: 176-179 ]

Key Words: Trauma, Spinal cord, Paraplegia

─ 177 ─

Deok Heon Lee, et al. Delayed Posttraumatic Spinal Epidural Hematoma: Importance of Early Surgical Treatment for Neurologic Deficits

Fig. 2. Axial (A) and sagittal (B) spinal magnetic resonance images showing dark-signal-intensity lesions (arrowhead in A and arrow in B), suggesting intrathecal hemorrhage at the T10 and T11 levels.

A B

Fig. 1. (A) Chest computed tomographic scan showing multiple rib fractures, left minimal pneumothorax, and right hemothorax with lung contusion. (B) Spinal computed tomographic scan showing multiple spinous process fractures and superior end-plate fractures at the T11 level (arrow and dashed line).

A B

─ 178 ─

- Journal of Trauma and Injury Vol. 29, No. 4 -

─ 179 ─

Deok Heon Lee, et al. Delayed Posttraumatic Spinal Epidural Hematoma: Importance of Early Surgical Treatment for Neurologic Deficits

REFERENCES

01) Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA. Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. Journal of neurosurgery 1995; 83: 1-7.

02) Foo D, Rossier AB. Post-traumatic spinal epidural hematoma.

Neurosurgery 1982; 11: 25-32.

03) Lefranc F, David P, Brotchi J, De Witte O. Traumatic epidural hematoma of the cervical spine: magnetic resonance imaging diagnosis and spontaneous resolution: case report. Neurosurgery 1999; 44: 408-10; discussion 10-1.

04) Cuenca PJ, Tulley EB, Devita D, Stone A. Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms. J Emerg Med 2004; 27: 37-41.

05) Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 1984; 61:

143-8.

06) Hsieh CT, Chiang YH, Tang CT, Sun JM, Ju DT. Delayed traumatic thoracic spinal epidural hematoma: a case report and literature review. Am J Emerg Med 2007; 25: 69-71.

07) Rodrigues LM, Abreu F, Fujiki EN, Milani C. Delayed trau- matic spinal epidural hematoma with neurological deficits.

Einstein (Sao Paulo) 2010; 8: 477-9.

08) Kaur K, Singh R, Prasath V, Magu S, Tanwar M. Computed

tomographic-based morphometric study of thoracic spine and

its relevance to anaesthetic and spinal surgical procedures. J

Clin Orthop Trauma 2016; 7: 101-8.